Diagnostic value of bronchoalveolar lavage in ventilator associated pneumonia of pediatric patients

The major difficulty facing microbial investigation in ventilator associated pneumonia [VAP] is to find a method of choice for distal airway sampling avoiding the contamination of upper respiratory colonizers. Since the inappropriate antibiotic treatment is associated with increased morbidity and mortality therefore the detection of the pathogen causing VAP remains the cornerstone in management. This study was conducted to evaluate the role of bronchoscopic bronchoalveolar lavage [BAL] in the etiologic diagnosis of VAP in Pediatric Intensive Care Unit of Ain Shams University Hospital. In addition, aimed to analyze the pulmonary and systemic inflammatory responses, reflected by levels of serum and BAL interleukin 6 [lL-6] and IL-8, and their association with morbidity and mortality. Thirty VAP patients and 10 mechanically ventilated patients without development of VAP [control group] were enrolled in the study. Endotracheal aspirate [ETA], BAL, and blood samples were collected from VAP patients for microbiological diagnosis. ETA and BAL samples were cultured quantitatively and the isolated organisms were identified by standard techniques. Antimicrobial susceptibility testing was done by disc diffusion method. Blood samples were collected from patients and controls for estimation of serum levels of IL-6 and IL-8. Also levels of these cytokines were estimated in BAL of VAP patients. Twenty four [80%] BAL cultures and 14 [46.7%] ETA cultures were considered positive [thresholds of >/= 10[4] and >/= 10[6] CFU/mL]. Blood cultures were positive in 8 [26.7%] patients. The concordance between BAL and ETA culture results was 66.7% with fair agreement [K= 0.359] while it was only 46.7% between blood and BAL culture results with poor agreement [K= 0.167]. Staphylococcus aureus isolates were recovered from patients with early-onset VAP. Pseudomonas aeruginosa and enteric Gram negative bacilli were the isolated pathogens in late-onset VAP and showed a wide range of antibiotic resistance. The rate of positive BAL culture was significantly higher in late-onset VAP patients [P<0.050]. Serum levels [ng/mL] of lL-6 and IL-8 were significantly higher in VAP patients than controls. VAP patients with sepsis had higher levels of serum and BAL IL-8 and IL-6 than VAP patients without sepsis [p < 0.0001]. BAL IL-6 had the greatest ability to discriminate between patients with and without lung injury. Serum and BAL lL-6 and IL-8 showed a statistically significant [P<0.001] increase in non-survivors among VAP patients and serum IL-8 had the greatest discriminating ability between survivors and non-survivors. Quantitative culture of BAL samples had the potential to be a useful tool for the etiological diagnosis of VAP among mechanically ventilated pediatric patients. However, lowering of the diagnostic threshold to discriminate infection from colonization in patients with prior antibiotic therapy has to be considered. BAL and serum levels of IL-8 and IL-6 might be promising markers for morbidity and poor prognosis in mechanically ventilated pediatric patients

Preeclamptic toxemia in chlamydia pneumoniae seropositive pregnant women

Women who develop preeclampsia may have an intense inflammatory response which may be caused by a concurrent or preceding inflammatory stimulus such as infection. This study was conducted to test the hypothesis that there is an association between Chlarnydia pneumoniae [C.pneumoniae] immunoglobulin [Ig] G seropositivity and development of preeclampsia in pregnant women. A prospective observational study was carried out on 355 healthy pregnant women attending the outpatient clinic at Ain Shams University Maternity Hospital. All women were normotensive primigravidae after 20 weeks of gestation. A single venous blood sample was collected from each of these women and tested for the presence of C.pneumoniae specific IgG antibodies using microimmunofluorescence technique [MIF]. Subsequently, women were classified as either seropositive or seronegative. Women in both groups were followed-up to detect the development of preeclampsia. A total of 248 women continued follow-up till delivery and were enrolled in the study. Seropositive group had a higher incidence of development of preeclampsia; 10% [11 cases developed preeclampsia of 107 seropositive women], compared to seronegative group; 2.8% [4 cases of 141,] and this difference was statistically significant using Chi-square test [p<0.05]. The longitudinal data of this study suggest a possible association between C.pneurnoniae seropositivity and preeclampsia and also support the evidence on infection hypothesis for the development of preeclampsia

Antibody response to Chlamydia Pneumonine and some proinflammatory cytokines in myocardial acute ischemic syndromes

This study was conducted on three matched groups of patients. Group I included 38 AIS patients, group II included 30 CCHD patients and group III included 20 healthy persons as a normal control group. C. p. specific IgM and IgG antibodies were investigated in the sera of all subjects using MIF, and CRP was titrated by latex agglutination, IL-6 and TNF-alpha serum levels were measured by EIA. The results support the hypothesis that C. p. reinfection is associated with AIS. The serum levels of IL-6 were significantly higher in AIS patients and tend to be higher [but without statistical significance] in AIS patients with high titers of C. p. specific IgG antibodies

Antibody level after measles vaccination

The present study was designed to estimate the level of measles IgG antibody in infants early after vaccination and in preschool children to determine their immune status. Three groups were studied: Group I, unvaccinated infants, Group II, recently vaccinated infants and Group III vaccinated preschool children. Measles IgG antibody was measured using the ELIZA technique. The study showed that 90% [18/20] of the unvaccinated Group I infants were seronegative and only 10% were seropositive for measles IgG antibody representing most probably persisting maternal antibodies. Fifty percent [15/30] of recently vaccinated Group II infants were seropositive. A statistically significant higher antibody level was observed in Group II infants in comparison to those of Group I. The majority of seropositive infants of Group II [10/15 = 66.7%] showed high antibody level representing successful vaccination. Seropositives represented 77.4% [24/31] of Group III preschool children and the majority of them 75% [18/24] showed high antibody level which was significantly higher than the comparable in Group II infants, most probably due to subclinical infection in addition to successful vaccination. Fifty percent [15/30] of Group II infants and 22.6% [7/31] of Group III children were seronegative, more likely due to failure of initial vaccination